Introduction

The menopause is when a woman stops having periods and is no longer able to get pregnant naturally.

Periods usually start to become less frequent over a few months or years before they stop altogether. Sometimes they can stop suddenly.

The menopause is a natural part of ageing that usually occurs between 45 and 55 years of age, as a woman's oestrogen levels decline. In the UK, the average age for a woman to reach the menopause is 51.

However, around 1 in 100 women experience the menopause before 40 years of age. This is known as premature menopause or premature ovarian insufficiency.

Symptoms of the menopause

Most women will experience menopausal symptoms. Some of these can be quite severe and have a significant impact on your everyday activities.

What causes the menopause?

The menopause is caused by a change in the balance of the body's sex hormones, which occurs as you get older.

It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month.

Premature or early menopause can occur at any age, and in many cases, there's no clear cause.

Sometimes it's caused by a treatment such as surgery to remove the ovaries (oophorectomy), some breast cancer treatments, chemotherapy](yourmd:/condition/chemotherapy/definition) or radiotherapy , or it can be brought on by an underlying medical condition, such as Down's syndrome or [Addison's disease .

Symptoms of the menopause

Most women will experience some symptoms around the menopause. The duration and severity of these symptoms varies from woman to woman.

Symptoms usually start a few months or years before your periods stop, known as the perimenopause, and can persist for some time afterwards.

On average, most symptoms last around four years from your last period. However, around 1 in every 10 women experience them for up to 12 years.

If you experience the menopause suddenly rather than gradually – for example, as a result of cancer treatment – your symptoms may be worse.

Changes to your periods

The first sign of the menopause is usually a change in the normal pattern of your periods.

Hormone replacement therapy (HRT)

HRT involves taking oestrogen to replace the decline in your body's own levels around the time of the menopause. This can relieve many of the associated symptoms.

HRT has been out of favour since the early 2000s because of a link with breast cancer, but new guidelines from the National Institute for Health and Care Excellence (NICE) say that HRT is effective and should be offered to women with menopausal symptoms, after discussing the risks and benefits.

There are two main types of HRT:

combined HRT (oestrogen and progestogen) – for women with menopausal symptoms who still have their womb (oestrogen taken on its own can otherwise increase your risk of womb cancer )

oestrogen-only HRT– for women who have had their womb removed in a hysterectomy

HRT is available as tablets, skin patches, a gel to rub into the skin or implants.

HRT is extremely effective at relieving menopausal symptoms, especially hot flushes and night sweats, but there are a number of side effects, including breast tenderness, headaches and vaginal bleeding. It's also associated with an increased risk of blood clots](yourmd:/condition/thrombosis/introduction) and [breast cancer in some women.

HRT is not advisable for some women, such as those who have had certain types of breast cancer or are at high risk of getting breast cancer.

Your doctor can give you more information about the risks and benefits of HRT to help you decide whether or not you want to take it.

If the flushes and sweats are frequent or severe, your doctor may suggest taking HRT.

If HRT isn't suitable for you, or you would prefer not to have it, your doctor may recommend other medications that can help, such as clonidine (a high blood pressure medicine) or certain antidepressants .

These medications can cause unpleasant side effects, so it's important to discuss the risks and benefits with your doctor before starting treatment.

Mood changes

Some women experience mood swings, low mood and anxiety around the time of the menopause.

Self-help measures such as getting plenty of rest, taking regular exercise and doing relaxing activities such as yoga and tai chi may help. Medication and other treatments are also available, including HRT and cognitive behavioural therapy (CBT) .

CBT is a type of talking therapy that can improve low mood and feelings of anxiety. Your doctor may be able to refer you for CBT or recommend self-help options such as online CBT courses.

Antidepressants may help if you've been diagnosed with depression .

Reduced sexual desire

It's common for women to lose interest in sex around the time of the menopause, but HRT can often help with this. If HRT isn't effective, you might be offered a testosterone supplement.

Testosterone is the male sex hormone, but it can help to restore sex drive in menopausal women. It’s not currently licensed for use in women, although it can be prescribed by a doctor if they think it might help.

Possible side effects of testosterone supplements include acne and unwanted hair growth .